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Flexible Fidelity: Adaptation of the ICU-PAUSE Handoff Tool During Implementation Across 11 ICUs
Elissa Arnold1, Rachel Wile2, Ella Cornell2
1Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, MO.
Importance:
Communication failures during patient handoffs from the ICU to the ward are common and negatively impact patients. Structured handoff communication tools may improve these transitions yet remain infrequently used.
Objectives:
Characterize local determinants of ICU-PAUSE handoff program perceived implementation success and describe adaptations made to the ICU-PAUSE tool and its implementation strategies during multicenter implementation.
Design, Setting, And Participants:
Qualitative study in 11 academic hospitals' medical ICUs. Participants were intensive care physicians who volunteered to champion ICU-PAUSE implementation at their respective institutions.
Analysis:
Thematic analysis of semi-structured interviews to understand determinants, artifact analysis to characterize adaptations, and retrospective post-implementation chart review of ICU-to-ward transfer notes to evaluate uptake and sustainability of the intervention.
Results:
Participants reported fewer perceived implementation barriers than expected, with many anticipated barriers ultimately functioning as important facilitators. Eight sites (73%) modified the ICU-PAUSE electronic template and/or its implementation strategies; most of the 29 unique adaptations described by participants involved adding new content to the standard template. Noncontent adaptations were largely contextual to fit site-specific needs and facilitate tool adoption. One year after implementation, the ICU-PAUSE template was used in 75% of ICU-to-ward transfer notes analyzed.
Conclusions:
ICU-PAUSE is a low-barrier intervention to improve ICU-ward handoff communication. This study highlights the importance of adaptability in the success of nationally scalable implementation efforts for bundled interventions like ICU-PAUSE.
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